Unlike with other highly salaried professions such as law, many states permit physicians to enter into employment contracts that include restrictive covenants (RCs), including noncompete clauses. These can prohibit a physician from working within a defined geographic area for a predetermined period of time after the end of an employment contract. Currently, only eight states have bans or restrictions on RCs. However, both ACEP and the American Academy of Emergency Medicine (AAEM) oppose them to varying degrees.

In some areas and practice environments, RCs appear to be common, but recently, some emergency physicians have fought them in court, finding success in some cases and failure in others. Experts such as Larry Weiss, MD, JD, professor of emergency medicine at the University of Maryland School of Medicine in Baltimore and former president of AAEM, believe that RCs are both widespread and onerous. He and others are worried that RCs might harm both physicians, who might literally have to uproot their families and move away if they were to leave their current jobs, and the communities they serve, which might face doctor shortages, should these contracts be strictly enforced.

Both ACEP and AAEM have supported some physicians in their legal struggles in some instances. For its part, ACEP opposes RCs with some exceptions, such as for individuals who have particularly strong business interests, including owners or partners of an independent physician group. AAEM has taken a harder line against RCs.

Ironically, RCs may not provide nearly as much economic benefit for employers as was previously believed. Therefore, observers such as ACEP President Paul Kivela, MD, MBA, FACEP, believe that physicians should be aware of RCs and discuss them openly at the time of employment so that bilateral expectations are clear from the beginning of any employment relationship. It may simply be that RCs fade away from common practice as their lack of practical usefulness (and, in some areas, their unenforceability) becomes more widely understood.

Dr. Millard, a frequent contributor to the Annals of Emergency Medicine “News and Perspective” section, is an independent journalist covering health, the built environment, culture, and other topics and is based in New York City.